Question Easy:
A 55-year-old woman presents with a four-month history of uncontrolled sweating, hand tremors, and unintentional weight loss. On examination, she has a diffusely enlarged thyroid gland.
What is the most likely diagnosis?
A) Hypothyroidism
B) Subacute thyroiditis
C) Graves’ disease
D) Thyroid nodule
E) Thyroid cancer
Question Medium:
A 45-year-old man presents with headaches, visual field defects, and bitemporal hemianopia. MRI of the brain shows a lesion in the sellar region.
What is the most likely diagnosis?
A) Pituitary adenoma
B) Meningioma
C) Craniopharyngioma
D) Glioblastoma
E) Aneurysm
Question Hard:
A 38-year-old woman presents with progressive muscle weakness, ptosis, and double vision which worsens in the evening. She has a history of thymoma.
Which investigation will best confirm the diagnosis?
A) MRI Brain
B) Serum creatine kinase (CK) levels
C) Acetylcholine receptor antibody test
D) Repetitive nerve stimulation study
E) Lumbar puncture with CSF analysis
Explanations & Answers:
Question Easy Answer:
C) Graves’ disease
Question Easy Explanation:
Graves’ disease is suggested by the combination of uncontrolled sweating, tremors, and weight loss along with a diffusely enlarged thyroid gland as per NICE guidelines. This autoimmune disorder leads to hyperthyroidism, which accounts for the symptoms described.
Question Medium Answer:
A) Pituitary adenoma
Question Medium Explanation:
A pituitary adenoma is a common cause of bitemporal hemianopia due to its anatomic proximity to the optic chiasm. The sellar MRI finding further supports this diagnosis. This aligns with guidelines for the management of pituitary disorders by the NHS.
Question Hard Answer:
C) Acetylcholine receptor antibody test
Question Hard Explanation:
Myasthenia gravis is characterized by muscle weakness, ptosis, and double vision (symptoms that worsen with fatigue), and it is often associated with thymoma. The acetylcholine receptor antibody test is the specific investigation for confirming this diagnosis, per BNF recommendations.
Medical fact of the day:
The hypothalamic-pituitary-adrenal (HPA) axis plays a crucial role in the body’s response to stress. If dysregulated, as in Cushing’s syndrome, it can lead to a plethora of systemic effects including central obesity, hypertension, and glucose intolerance.
Quote of the day:
“In the midst of challenges, remember that healing hands and compassionate hearts can transform lives. Your work matters every single day.”